|
HC LUM SPINE BEND ONLY/4 VIEWS
|
Facility
|
OP
|
$1,439.00
|
|
|
Service Code
|
CPT 72120
|
| Hospital Charge Code |
909001318
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.53 |
| Max. Negotiated Rate |
$1,295.10 |
| Rate for Payer: Adventist Health Commercial |
$287.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$254.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$185.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$258.27
|
| Rate for Payer: Blue Shield of California Commercial |
$906.57
|
| Rate for Payer: Blue Shield of California EPN |
$571.28
|
| Rate for Payer: Cash Price |
$647.55
|
| Rate for Payer: Cash Price |
$647.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,151.20
|
| Rate for Payer: Cigna of CA HMO |
$920.96
|
| Rate for Payer: Cigna of CA PPO |
$1,064.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,007.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,223.15
|
| Rate for Payer: Global Benefits Group Commercial |
$863.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,295.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$913.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$287.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,079.25
|
| Rate for Payer: Networks By Design Commercial |
$935.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$1,223.15
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$863.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$863.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC LUM SPINE BEND ONLY/4 VIEWS
|
Facility
|
IP
|
$1,439.00
|
|
|
Service Code
|
CPT 72120
|
| Hospital Charge Code |
909001318
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$287.80 |
| Max. Negotiated Rate |
$1,295.10 |
| Rate for Payer: Adventist Health Commercial |
$287.80
|
| Rate for Payer: Cash Price |
$647.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,151.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,007.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$575.60
|
| Rate for Payer: EPIC Health Plan Senior |
$575.60
|
| Rate for Payer: Galaxy Health WC |
$1,223.15
|
| Rate for Payer: Global Benefits Group Commercial |
$863.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,295.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$913.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$849.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$287.80
|
| Rate for Payer: Multiplan Commercial |
$1,079.25
|
| Rate for Payer: Networks By Design Commercial |
$935.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,223.15
|
|
|
HC LUM SPINE COMP W/BENDING VIEWS
|
Facility
|
OP
|
$2,224.00
|
|
|
Service Code
|
CPT 72114
|
| Hospital Charge Code |
909001316
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.01 |
| Max. Negotiated Rate |
$2,001.60 |
| Rate for Payer: Adventist Health Commercial |
$444.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$355.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$246.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$342.42
|
| Rate for Payer: Blue Shield of California Commercial |
$1,401.12
|
| Rate for Payer: Blue Shield of California EPN |
$882.93
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,779.20
|
| Rate for Payer: Cigna of CA HMO |
$1,423.36
|
| Rate for Payer: Cigna of CA PPO |
$1,645.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,556.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,890.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,334.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,001.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$91.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,412.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$100.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,668.00
|
| Rate for Payer: Networks By Design Commercial |
$1,445.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$1,890.40
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,334.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,334.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC LUM SPINE COMP W/BENDING VIEWS
|
Facility
|
IP
|
$2,224.00
|
|
|
Service Code
|
CPT 72114
|
| Hospital Charge Code |
909001316
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$444.80 |
| Max. Negotiated Rate |
$2,001.60 |
| Rate for Payer: Adventist Health Commercial |
$444.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,779.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,556.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$889.60
|
| Rate for Payer: EPIC Health Plan Senior |
$889.60
|
| Rate for Payer: Galaxy Health WC |
$1,890.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,334.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,001.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,412.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,312.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.80
|
| Rate for Payer: Multiplan Commercial |
$1,668.00
|
| Rate for Payer: Networks By Design Commercial |
$1,445.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,890.40
|
|
|
HC LUM SPINE W/OBLIQUES
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
CPT 72110
|
| Hospital Charge Code |
909001317
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$320.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Adventist Health Commercial |
$320.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,280.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$640.00
|
| Rate for Payer: EPIC Health Plan Senior |
$640.00
|
| Rate for Payer: Galaxy Health WC |
$1,360.00
|
| Rate for Payer: Global Benefits Group Commercial |
$960.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,440.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,016.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$944.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.00
|
| Rate for Payer: Multiplan Commercial |
$1,200.00
|
| Rate for Payer: Networks By Design Commercial |
$1,040.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,360.00
|
|
|
HC LUM SPINE W/OBLIQUES
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
CPT 72110
|
| Hospital Charge Code |
909001317
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$75.42 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Adventist Health Commercial |
$320.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$254.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$190.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$264.87
|
| Rate for Payer: Blue Shield of California Commercial |
$1,008.00
|
| Rate for Payer: Blue Shield of California EPN |
$635.20
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,280.00
|
| Rate for Payer: Cigna of CA HMO |
$1,024.00
|
| Rate for Payer: Cigna of CA PPO |
$1,184.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,360.00
|
| Rate for Payer: Global Benefits Group Commercial |
$960.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,440.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$75.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,016.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$83.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,200.00
|
| Rate for Payer: Networks By Design Commercial |
$1,040.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$1,360.00
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$960.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$960.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC LUNG BIOPSY, PERCUTANEOUS
|
Facility
|
IP
|
$4,488.00
|
|
|
Service Code
|
CPT 32405
|
| Hospital Charge Code |
909000124
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$897.60 |
| Max. Negotiated Rate |
$4,039.20 |
| Rate for Payer: Adventist Health Commercial |
$897.60
|
| Rate for Payer: Cash Price |
$2,019.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,590.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,141.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,795.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,795.20
|
| Rate for Payer: Galaxy Health WC |
$3,814.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,692.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,039.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,849.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,647.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$897.60
|
| Rate for Payer: Multiplan Commercial |
$3,366.00
|
| Rate for Payer: Networks By Design Commercial |
$2,917.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,814.80
|
|
|
HC LUNG BIOPSY, PERCUTANEOUS
|
Facility
|
OP
|
$4,488.00
|
|
|
Service Code
|
CPT 32405
|
| Hospital Charge Code |
909000124
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$897.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$897.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,814.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,468.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,366.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$2,019.60
|
| Rate for Payer: Cash Price |
$2,019.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,590.40
|
| Rate for Payer: Cigna of CA HMO |
$2,872.32
|
| Rate for Payer: Cigna of CA PPO |
$3,321.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,814.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,814.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,814.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,141.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,795.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,795.20
|
| Rate for Payer: Galaxy Health WC |
$3,814.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,692.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,039.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,849.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,629.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,647.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$897.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,141.60
|
| Rate for Payer: Multiplan Commercial |
$3,366.00
|
| Rate for Payer: Networks By Design Commercial |
$2,917.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,814.80
|
| Rate for Payer: Riverside University Health System MISP |
$1,795.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,692.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,244.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,244.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,244.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,244.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,814.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,814.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,814.80
|
|
|
HC LUNG DIFFER PERF & VENTILATION
|
Facility
|
IP
|
$4,060.00
|
|
|
Service Code
|
CPT 78598
|
| Hospital Charge Code |
909301402
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$812.00 |
| Max. Negotiated Rate |
$3,654.00 |
| Rate for Payer: Adventist Health Commercial |
$812.00
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,248.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,842.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,624.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,624.00
|
| Rate for Payer: Galaxy Health WC |
$3,451.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,436.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,654.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,578.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,395.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$812.00
|
| Rate for Payer: Multiplan Commercial |
$3,045.00
|
| Rate for Payer: Networks By Design Commercial |
$2,639.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,451.00
|
|
|
HC LUNG DIFFER PERF & VENTILATION
|
Facility
|
OP
|
$4,060.00
|
|
|
Service Code
|
CPT 78598
|
| Hospital Charge Code |
909301402
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$466.64 |
| Max. Negotiated Rate |
$3,654.00 |
| Rate for Payer: Adventist Health Commercial |
$812.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$698.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,580.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$698.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,583.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,201.55
|
| Rate for Payer: Blue Shield of California Commercial |
$2,557.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,611.82
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,248.00
|
| Rate for Payer: Cigna of CA HMO |
$2,598.40
|
| Rate for Payer: Cigna of CA PPO |
$3,004.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$698.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,842.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.28
|
| Rate for Payer: EPIC Health Plan Senior |
$768.18
|
| Rate for Payer: Galaxy Health WC |
$3,451.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,436.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,654.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,145.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$466.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$698.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,578.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$515.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$977.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$812.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$935.79
|
| Rate for Payer: Multiplan Commercial |
$3,045.00
|
| Rate for Payer: Networks By Design Commercial |
$2,639.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$698.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,451.00
|
| Rate for Payer: Prime Health Services Medicare |
$740.25
|
| Rate for Payer: Riverside University Health System MISP |
$768.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,436.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,436.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$809.82
|
| Rate for Payer: United Healthcare All Other HMO |
$809.82
|
| Rate for Payer: United Healthcare HMO Rider |
$809.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$809.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$698.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Vantage Medical Group Senior |
$698.35
|
|
|
HC LUPUS SCREEN PTT
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
900912006
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.80
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
|
|
HC LUPUS SCREEN PTT
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
900912006
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.01
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$43.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$43.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.74
|
| Rate for Payer: Blue Shield of California Commercial |
$37.80
|
| Rate for Payer: Blue Shield of California Commercial |
$115.92
|
| Rate for Payer: Blue Shield of California EPN |
$23.82
|
| Rate for Payer: Blue Shield of California EPN |
$73.05
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| Rate for Payer: Cigna of CA HMO |
$38.40
|
| Rate for Payer: Cigna of CA HMO |
$117.76
|
| Rate for Payer: Cigna of CA PPO |
$44.40
|
| Rate for Payer: Cigna of CA PPO |
$136.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.92
|
| Rate for Payer: EPIC Health Plan Senior |
$6.61
|
| Rate for Payer: EPIC Health Plan Senior |
$6.61
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.86
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.05
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.01
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.01
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
| Rate for Payer: Prime Health Services Medicare |
$6.37
|
| Rate for Payer: Prime Health Services Medicare |
$6.37
|
| Rate for Payer: Riverside University Health System MISP |
$6.61
|
| Rate for Payer: Riverside University Health System MISP |
$6.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.87
|
| Rate for Payer: United Healthcare All Other HMO |
$4.87
|
| Rate for Payer: United Healthcare All Other HMO |
$4.87
|
| Rate for Payer: United Healthcare HMO Rider |
$4.87
|
| Rate for Payer: United Healthcare HMO Rider |
$4.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.87
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Vantage Medical Group Senior |
$6.01
|
| Rate for Payer: Vantage Medical Group Senior |
$6.01
|
|
|
HC LUTEINIZING HORMON
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
900910886
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.40 |
| Max. Negotiated Rate |
$271.80 |
| Rate for Payer: Adventist Health Commercial |
$60.40
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Central Health Plan Commercial |
$241.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$211.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.80
|
| Rate for Payer: EPIC Health Plan Senior |
$120.80
|
| Rate for Payer: Galaxy Health WC |
$256.70
|
| Rate for Payer: Global Benefits Group Commercial |
$181.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$271.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$191.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$178.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.40
|
| Rate for Payer: Multiplan Commercial |
$226.50
|
| Rate for Payer: Networks By Design Commercial |
$196.30
|
| Rate for Payer: Prime Health Services Commercial |
$256.70
|
|
|
HC LUTEINIZING HORMON
|
Facility
|
OP
|
$302.00
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
900910886
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$271.80 |
| Rate for Payer: Adventist Health Commercial |
$60.40
|
| Rate for Payer: Adventist Health Commercial |
$18.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.52
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$134.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$134.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$187.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$187.32
|
| Rate for Payer: Blue Shield of California Commercial |
$57.96
|
| Rate for Payer: Blue Shield of California Commercial |
$190.26
|
| Rate for Payer: Blue Shield of California EPN |
$36.52
|
| Rate for Payer: Blue Shield of California EPN |
$119.89
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Central Health Plan Commercial |
$241.60
|
| Rate for Payer: Central Health Plan Commercial |
$73.60
|
| Rate for Payer: Cigna of CA HMO |
$58.88
|
| Rate for Payer: Cigna of CA HMO |
$193.28
|
| Rate for Payer: Cigna of CA PPO |
$68.08
|
| Rate for Payer: Cigna of CA PPO |
$223.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$211.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$64.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.56
|
| Rate for Payer: EPIC Health Plan Senior |
$20.37
|
| Rate for Payer: EPIC Health Plan Senior |
$20.37
|
| Rate for Payer: Galaxy Health WC |
$78.20
|
| Rate for Payer: Galaxy Health WC |
$256.70
|
| Rate for Payer: Global Benefits Group Commercial |
$55.20
|
| Rate for Payer: Global Benefits Group Commercial |
$181.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$82.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$271.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.37
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$191.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$58.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.82
|
| Rate for Payer: Multiplan Commercial |
$69.00
|
| Rate for Payer: Multiplan Commercial |
$226.50
|
| Rate for Payer: Networks By Design Commercial |
$196.30
|
| Rate for Payer: Networks By Design Commercial |
$59.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.52
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.52
|
| Rate for Payer: Prime Health Services Commercial |
$78.20
|
| Rate for Payer: Prime Health Services Commercial |
$256.70
|
| Rate for Payer: Prime Health Services Medicare |
$19.63
|
| Rate for Payer: Prime Health Services Medicare |
$19.63
|
| Rate for Payer: Riverside University Health System MISP |
$20.37
|
| Rate for Payer: Riverside University Health System MISP |
$20.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$181.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$181.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15.00
|
| Rate for Payer: United Healthcare HMO Rider |
$15.00
|
| Rate for Payer: United Healthcare HMO Rider |
$15.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.52
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.37
|
| Rate for Payer: Vantage Medical Group Senior |
$18.52
|
| Rate for Payer: Vantage Medical Group Senior |
$18.52
|
|
|
HC LVAD DRSNG KIT W/PVP
|
Facility
|
IP
|
$377.17
|
|
| Hospital Charge Code |
901698966
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.43 |
| Max. Negotiated Rate |
$339.45 |
| Rate for Payer: Adventist Health Commercial |
$75.43
|
| Rate for Payer: Cash Price |
$169.73
|
| Rate for Payer: Central Health Plan Commercial |
$301.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$264.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.87
|
| Rate for Payer: EPIC Health Plan Senior |
$150.87
|
| Rate for Payer: Galaxy Health WC |
$320.59
|
| Rate for Payer: Global Benefits Group Commercial |
$226.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$339.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$239.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$222.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.43
|
| Rate for Payer: Multiplan Commercial |
$282.88
|
| Rate for Payer: Networks By Design Commercial |
$245.16
|
| Rate for Payer: Prime Health Services Commercial |
$320.59
|
|
|
HC LVAD DRSNG KIT W/PVP
|
Facility
|
OP
|
$377.17
|
|
| Hospital Charge Code |
901698966
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.43 |
| Max. Negotiated Rate |
$339.45 |
| Rate for Payer: Adventist Health Commercial |
$75.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$282.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$182.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$219.40
|
| Rate for Payer: Blue Shield of California Commercial |
$239.13
|
| Rate for Payer: Blue Shield of California EPN |
$150.49
|
| Rate for Payer: Cash Price |
$169.73
|
| Rate for Payer: Central Health Plan Commercial |
$301.74
|
| Rate for Payer: Cigna of CA HMO |
$241.39
|
| Rate for Payer: Cigna of CA PPO |
$279.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$320.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$320.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$264.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.87
|
| Rate for Payer: EPIC Health Plan Senior |
$150.87
|
| Rate for Payer: Galaxy Health WC |
$320.59
|
| Rate for Payer: Global Benefits Group Commercial |
$226.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$339.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$239.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$136.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$222.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$264.02
|
| Rate for Payer: Multiplan Commercial |
$282.88
|
| Rate for Payer: Networks By Design Commercial |
$245.16
|
| Rate for Payer: Prime Health Services Commercial |
$320.59
|
| Rate for Payer: Riverside University Health System MISP |
$150.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$226.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$226.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.59
|
| Rate for Payer: United Healthcare All Other HMO |
$188.59
|
| Rate for Payer: United Healthcare HMO Rider |
$188.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$320.59
|
| Rate for Payer: Vantage Medical Group Senior |
$320.59
|
|
|
HC LVN EPSDT
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 99347
|
| Hospital Charge Code |
903400601
|
|
Hospital Revenue Code
|
582
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
|
|
HC LVN EPSDT
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 99347
|
| Hospital Charge Code |
903400601
|
|
Hospital Revenue Code
|
582
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$300.40 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$300.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$29.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.90
|
| Rate for Payer: Blue Shield of California Commercial |
$38.04
|
| Rate for Payer: Blue Shield of California EPN |
$23.94
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| Rate for Payer: Cigna of CA HMO |
$38.40
|
| Rate for Payer: Cigna of CA PPO |
$44.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$68.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Riverside University Health System MISP |
$24.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.00
|
| Rate for Payer: Vantage Medical Group Senior |
$51.00
|
|
|
HC LVN EPSDT (15 MINS)
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 99347
|
| Hospital Charge Code |
903400843
|
|
Hospital Revenue Code
|
580
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$300.40 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$300.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.63
|
| Rate for Payer: Blue Shield of California Commercial |
$12.68
|
| Rate for Payer: Blue Shield of California EPN |
$7.98
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$68.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Riverside University Health System MISP |
$8.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.00
|
|
|
HC LVN EPSDT (15 MINS)
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 99347
|
| Hospital Charge Code |
903400843
|
|
Hospital Revenue Code
|
580
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
HC LVN IRC (60 MINS)
|
Facility
|
OP
|
$144.00
|
|
| Hospital Charge Code |
903400757
|
|
Hospital Revenue Code
|
582
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Adventist Health Commercial |
$28.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$87.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$122.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$79.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$108.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.76
|
| Rate for Payer: Blue Shield of California Commercial |
$91.30
|
| Rate for Payer: Blue Shield of California EPN |
$57.46
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Central Health Plan Commercial |
$115.20
|
| Rate for Payer: Cigna of CA HMO |
$92.16
|
| Rate for Payer: Cigna of CA PPO |
$106.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$122.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$122.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$122.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$100.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.60
|
| Rate for Payer: EPIC Health Plan Senior |
$57.60
|
| Rate for Payer: Galaxy Health WC |
$122.40
|
| Rate for Payer: Global Benefits Group Commercial |
$86.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$129.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$91.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$100.80
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$93.60
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
| Rate for Payer: Riverside University Health System MISP |
$57.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$86.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$86.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$122.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$122.40
|
| Rate for Payer: Vantage Medical Group Senior |
$122.40
|
|
|
HC LVN IRC (60 MINS)
|
Facility
|
IP
|
$144.00
|
|
| Hospital Charge Code |
903400757
|
|
Hospital Revenue Code
|
582
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Adventist Health Commercial |
$28.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Central Health Plan Commercial |
$115.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$100.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.60
|
| Rate for Payer: EPIC Health Plan Senior |
$57.60
|
| Rate for Payer: Galaxy Health WC |
$122.40
|
| Rate for Payer: Global Benefits Group Commercial |
$86.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$129.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$91.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$93.60
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
|
|
HC LYMPHANGIOGRAM, ABD/PLV UL
|
Facility
|
OP
|
$1,722.00
|
|
|
Service Code
|
CPT 75805
|
| Hospital Charge Code |
909001374
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$224.91 |
| Max. Negotiated Rate |
$6,700.73 |
| Rate for Payer: Adventist Health Commercial |
$344.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,061.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,588.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,269.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,765.23
|
| Rate for Payer: Blue Shield of California Commercial |
$1,084.86
|
| Rate for Payer: Blue Shield of California EPN |
$683.63
|
| Rate for Payer: Cash Price |
$774.90
|
| Rate for Payer: Cash Price |
$774.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,377.60
|
| Rate for Payer: Cigna of CA HMO |
$1,102.08
|
| Rate for Payer: Cigna of CA PPO |
$1,274.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,205.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$1,463.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,033.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,549.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$224.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,093.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$248.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$344.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$1,291.50
|
| Rate for Payer: Networks By Design Commercial |
$1,119.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,463.70
|
| Rate for Payer: Prime Health Services Medicare |
$4,304.71
|
| Rate for Payer: Riverside University Health System MISP |
$4,467.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,033.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,033.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,088.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1,088.13
|
| Rate for Payer: United Healthcare HMO Rider |
$1,088.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,088.13
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC LYMPHANGIOGRAM, ABD/PLV UL
|
Facility
|
IP
|
$1,722.00
|
|
|
Service Code
|
CPT 75805
|
| Hospital Charge Code |
909001374
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$344.40 |
| Max. Negotiated Rate |
$1,549.80 |
| Rate for Payer: Adventist Health Commercial |
$344.40
|
| Rate for Payer: Cash Price |
$774.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,377.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,205.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$688.80
|
| Rate for Payer: EPIC Health Plan Senior |
$688.80
|
| Rate for Payer: Galaxy Health WC |
$1,463.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,033.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,549.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,093.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,015.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$344.40
|
| Rate for Payer: Multiplan Commercial |
$1,291.50
|
| Rate for Payer: Networks By Design Commercial |
$1,119.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,463.70
|
|
|
HC LYMPHANGIOGRAM EXT BILAT
|
Facility
|
IP
|
$2,579.00
|
|
|
Service Code
|
CPT 75803
|
| Hospital Charge Code |
909001373
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$515.80 |
| Max. Negotiated Rate |
$2,321.10 |
| Rate for Payer: Adventist Health Commercial |
$515.80
|
| Rate for Payer: Cash Price |
$1,160.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,063.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,805.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,031.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,031.60
|
| Rate for Payer: Galaxy Health WC |
$2,192.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,547.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,321.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,637.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,521.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.80
|
| Rate for Payer: Multiplan Commercial |
$1,934.25
|
| Rate for Payer: Networks By Design Commercial |
$1,676.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,192.15
|
|
